At what point might I consider drug therapy and what are the options?
If you're unable to make the lifestyle changes listed above, or you do and your symptoms are still troublesome, you may consider trying medication. Because symptoms of menopause are caused by decreasing estrogen, one approach is to replace the estrogen you are losing.
Estrogen therapy, called ET, is the most effective treatment for menopausal symptoms. Sometimes, ET is given as tablets or capsules that you take by mouth, but it can also be given as a patch or a ring that is placed in your vagina. If you still have a uterus (it hasn't been removed by hysterectomy), your doctor may give you progestin with estrogen. And, if you're sexually active, your doctor may prescribe oral contraceptives because they contain estrogen, too.
There has been a lot of publicity about estrogens lately based on some research studies that showed that estrogens increase the chance of getting cancer of the uterus and may increase the risk of heart trouble, especially in older women. Because of this, your doctor will prescribe estrogens at the lowest dose possible for your treatment and only as long as needed. Pharmacists who dispense estrogens will always include written information with your prescription. Be sure to read it carefully before you start taking estrogens.
Your doctor might also suggest trying a drug called a selective serotonin/norepinephrine reuptake inhibitor. These drugs were originally developed to treat depression, but also seem to reduce the number and severity of hot flashes for many women. They may also help if you have problems with irritability or mood swings. Side effects of these agents may include headache, dry mouth, nausea, difficulty sleeping and sexual dysfunction.
Some women turn to complementary and alternative medicine therapy, or "herbal treatments," for relief. There is no proof that any of the most popular remedies – plant-derived phytoestrogens from soy supplements, black cohosh or vitamin E – are effective. For some women, they may offer some relief, however.
If I decide to use medicine to address my symptoms, what do I need to know?
You should never use estrogens if you have unusual vaginal bleeding, currently have or have had certain cancers, have had a stroke or heart attack in the past year or have blood clots or liver problems. You should also avoid estrogens if you think you may be pregnant. You should use any medicine for menopausal symptoms at the lowest dose possible to get relief and only as long as needed. Read all of the written material when you fill your prescription, and call your doctor or pharmacist if you have questions.
Note: This article was originally published on July 15, 2011 on PharmacyTimes.com. It has been edited and republished by U.S. News.